Healthcare Provider Details

I. General information

NPI: 1255840955
Provider Name (Legal Business Name): SAM LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3232 S MILL AVE
TEMPE AZ
85282-3656
US

IV. Provider business mailing address

3232 S MILL AVE
TEMPE AZ
85282-3656
US

V. Phone/Fax

Practice location:
  • Phone: 480-858-9044
  • Fax: 480-858-9148
Mailing address:
  • Phone: 480-858-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS022705
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: